PHNG NGA RUNG NH (PREVENTION OF ATRIAL FIBRILLATION)

BS L HU QUNH TRANG

ATRIAL FIBRILLATION (AF)

www.mayoclinic.com

AF

www.atrialfibrillation.org.uk

European Heart Journal (2010) 31, 23692429

European Heart Journal (2010) 31, 23692429

European Heart Journal (2010) 31, 23692429

Benjamin E J et al. Circulation 2009;119:606-618

Copyright American Heart Association

EPIDEMIOLOGY
Vietnam: 0.3% population 2.2 million Americans 4.5 million people in the European Union It's the most common "serious" heart rhythm abnormality in people over the age of 65 years.

Circulation. 2006; 114: 119-125; JAMA. 2001 May 9;285(18):2370-5; www.agingresearch.org

SIGNIFICANCE OF PRBLEM
Increasing prevalence and incidence of AF Many complications and high cost of AF Medical and interventional treatments are available but are not without risk
An ounce of prevention is worth a pound of cure

Prevention of AF
Risk factors that predispose individuals to the development of AF: - Hypertension -Hyperthyroidism
-Obstructive sleep apnea -Obesity -Atrial premature beats -High NTproBNP -PR prolongation -Congestive heart failure - Diabetes -Coronary artery disease -Valvular heart disease

HYPERTHYROIDISM AND AF

-AF occurs in up to 15% of patients with hyperthyroidism -In all patients with AF, before treatment, we should remember the association with thyroid diseases, as sinus rhythm is often restored after normal levels of thyroid hormones are achieved
Thyroid Research 2009, 2:4

HYPERTENSION AND AF
Most common risk factor Diastolic dysfunction Atrial stretch-fibrosis Use ACE inhibitors, Angiotensin II receptor blockers reduction of fibrosis, atrial remodeling

OBSTUCTIVE SLEEP APNEA(OSA) AND AF

Hemodynamic, neurohormonal, metabolic disorders AF OSA promotes development other risks of AF 2.2 fold increased risk for AF untreated OSA

OBESITY AND AF

Circulation. 2013; 128: 401-405

Venn diagram demonstrating overlap between obesity, atrial fibrillation, and selected clinical correlates.

X5

Magnani J W et al. Circulation 2013;128:401-405

Copyright American Heart Association

PR PROLONGATION AND AF

JAMA. 2009;301(24):2571-2577. doi:10.1001/jama.2009.888

ATRIAL PREMATURE BEATS AND AF

99% of people over the age of 50 had at least one PAC on 24-hour Holter monitoring Frequent PACs predicted that someone in the 6.1-year follow-up would develop A-Fib.

European Society of Cardiology) (2012) 14, 942-947; Circulation October 9, 2012.

In patients with acute ischemic stroke, frequent APBs (70/24 hours) are a marker for individuals who are at greater risk to develop or have paroxysmal AF. For such patients, we propose a diagnostic workup with repeated prolonged ECG monitoring to diagnose paroxysmal AF Stroke. 2007;38:2292-2294

NT-proBNP AND AF

The AF incidence associated with the lowest quintile of baseline BNP was 1.2% as compared to 5.1% in the 5th quintile

ATRIAL ENLARGEMENT AND AF

-Every 5-mm increase in LA diameter (TM) increased the

development of AF by 39% (Framingham Heart Study) -A four-fold increase in the risk of new AF with LA diameter 0.5 mm (Cardiovascular Health Study)

Circulation. 1994;89(2):724730; Circulation. 1997; 96(7):24552461.

AF RISK FACTORS

Obesity Overweight

Increased Left Atrial Diameter (LAD) Left Ventricular Enlargement or Hypertrophy

New Onset Atrial Fibrillation

Hypertension Heart Failure

Prussak, K. (2008). Prevention of New-Onset Atrial Fibrillation.

ACEIs and ARBs

-Loartan>Atenolol -33% reduction in newonset AF (LIFE) -Valsartan>Amlodipin- new-onset AF was less frequent in the valsartan-treated group than in the amlodipine-treated group (P = 0.0455) (VALUE) -Ramipril >Placebo-reducing recurrence AF in lone AF (P<0.03)
Europace (2011) 13 (3): 308-328. J Am Coll Cardiol. 2009 Jan 6;53(1):24-9.

STATINS
Decreased inflammation, oxidative stress, fibrosis Risk reduction for new onset AF 28-52% in participants with IHD and CHF Statin use preop ->risk reduction for postop AF 48-77%

QJM (2008) 101 (11): 845-861.

OMEGA 3
Several small trials have suggested that treatment for paroxysmal AF with prescription omega-3 fatty acids may provide a safe and effective treatment option. However, no benefit has been found to date Pharmacological supplementation with 1 g of n-3 PUFA for 1 year did not reduce recurrent AF.

J Am Coll Cardiol. 2013;61(4):463-468. doi:10.1016/j.jacc.2012.11.021

RECOMMENDATIONS
EXAMINATION ECG ECHOCARDIOGRAPHY HOLTER ECG +/-NT PRO BNP -DIET -PHYSICAL ACTIVITY -CONTROL BLOOD PRESSURE, GLUCOSE, LIPID PROFILES, ARRHYTHMIAS -ADJUST MEDICATIONS MAY CAUSE PR PROLONGATION

CONCLUSIONS
AF is a common arrhythmias and has many complications Necessary to identify risk factor modification to decrease risk of AF based on update knowledge Prevention of AF is meaningful because AF begets AF.